Provider Demographics
NPI:1811460215
Name:SELNER, MAUREEN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:SELNER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 JOSEPH D KOLLAR RD
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:NY
Mailing Address - Zip Code:12451-1113
Mailing Address - Country:US
Mailing Address - Phone:518-821-0277
Mailing Address - Fax:
Practice Address - Street 1:325 BROADWAY STE 403
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3654
Practice Address - Country:US
Practice Address - Phone:347-491-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist